• Disease constantly present in a region.
  🩸 Example: Malaria in NE India.

• Worldwide spread of a disease.
  🌍 Example: COVID-19.

• Sudden rise in cases above expected level.
  🦠 Example: Dengue outbreak.

• Zero transmission of a disease in a defined area, but agent may still exist elsewhere.
  ✅ Example: Polio eliminated from India (2014).

• Permanent global removal of infection → no natural cases worldwide.
  🌏 Example: Smallpox (1980).

• Reduction of disease incidence to acceptable level.
  🎯 Goal: Maintain with continued effort.

• Routine, continuous check of health data or program activities.
  📈 Example: Monitoring BP in hypertensives.

• Systematic collection + analysis + action on health data.
  👁️ Example: IDSP for communicable diseases.

• Ultimate long-term aim (e.g., Eliminate TB by 2025).

• Specific, measurable short-term target (e.g., Detect 90% TB cases by 2024).

How to answer:
Enumerate major components + stress on their health link.

Model Answer:
Environmental sanitation refers to control of all factors in the environment that affect human health.

Main components:
1️⃣ Safe water supply
2️⃣ Excreta disposal
3️⃣ Solid waste management
4️⃣ Food hygiene
5️⃣ Vector control
6️⃣ Housing & air quality
7️⃣ Control of noise & radiation

💡 Tip:
Remember mnemonic “WE-FAV-HC” — Water, Excreta, Food, Air, Vector, Housing, Climate

How to answer:
Mention sources, purification, and residual chlorine monitoring.

Model Answer:
To ensure safe water:

• Promote protected sources (tube wells, piped supply).
• Use household chlorination (1 mg/L residual chlorine).
• Ensure regular testing for bacteriological safety using orthotolidine test.
• Educate community on safe storage (narrow-mouthed, covered vessels).

💡 Tip:
Quote — “Safe water saves lives; surveillance ensures safety.”

Steps of outbreak investigation:
1️⃣ Establish existence of outbreak
2️⃣ Verify diagnosis
3️⃣ Define & identify cases
4️⃣ Describe by time, place, person
5️⃣ Develop hypotheses
6️⃣ Evaluate hypotheses
7️⃣ Refine & implement control measures
8️⃣ Communicate findings
9️⃣ Maintain surveillance
10️⃣ Prepare final report

💡 Tip:
Say — “IDSP trains officers in these steps — it’s the backbone of epidemic intelligence in India.”

Model Answer:
Launched in 2004, IDSP provides real-time surveillance and outbreak detection of epidemic-prone diseases.

Data sources:

• Weekly reports from sub-centre, PHC, CHC, district levels.
• Disease reporting formats (S, P, L).
• Rapid Response Teams (RRTs) investigate outbreaks.

Uses:
Early warning → prompt action → prevention of epidemics.

💡 Tip:
Say: “COVID-19 dashboard and Nipah surveillance were strengthened through IDSP platforms.”

BMW (Management & Handling) Rules, 28^th March 2016

• Under Ministry of Environment and Forests and Climate Change ^{Q CMS 2007}

1️⃣ Hand hygiene (WHO 5 moments)
2️⃣ PPE use
3️⃣ Aseptic techniques during invasive procedures
4️⃣ Biomedical waste segregation
5️⃣ Antimicrobial stewardship committee
6️⃣ Regular staff training

💡 Tip:
Say — “Infection control is everyone’s responsibility, not just the microbiologist’s.”

Model Answer:
Four phases:
1️⃣ Mitigation – Prevent or minimize risk (building codes, vaccination).
2️⃣ Preparedness – Emergency planning, mock drills.
3️⃣ Response – Immediate rescue, triage, and medical relief.
4️⃣ Recovery – Rehabilitation, disease surveillance, psychological support.

💡 Tip:
“Disaster management begins before disaster strikes — through preparedness.”

Model Answer:
Health effects:

• Acute: Eye irritation, cough, bronchitis, asthma.
• Chronic: COPD, lung cancer, ischemic heart disease, stroke.
• Children: Growth retardation, low IQ, wheezing.

Prevention:

• Source control (vehicular emission norms, CNG use).
• Public health advisories on AQI.
• Promote green transport & urban greenery.
• Masks & indoor air purifiers in high-risk groups.

💡 Tip:
Quote — “Air pollution is the new tobacco” (WHO).

Describe the three-tier system briefly — subcentre, PHC, CHC, and referral linkages.

Model Answer:
India’s health system follows a three-tier structure:

💡 Tip:
Always end by saying — “Ayushman Bharat now links all 3 levels through Health & Wellness Centres and digital integration.”

• Age – ASHA must be a woman between 25 to 45 years of age.
• ASHA must have had formal education up to at least 8^th
  ASHA must be a resident of the village.
  ASHA may be a married, widowed or divorced woman.
• Asha get incentive on 45^th day of birth

ASHA (Accredited Social Health Activist) is a female community health volunteer, one per 1,000 population, introduced under NHM in 2005.

Roles:

• Mobilize women for ANC, institutional delivery, immunization.
• Track left-out beneficiaries (immunization, FP, TB).
• Provide DOTS for TB and home-based newborn care.
• Act as a bridge between community and health system.

Incentives:
Performance-based — JSY, FP, immunization, etc.

💡 Tip: Mention “ASHA = 3 Rs: Recruit, Refer, Record.”

National Health Mission (NHM) was launched in 2013, integrating NRHM (2005) and NUHM (2013) to provide universal access to equitable, affordable healthcare.

Components:

• NRHM: Rural areas → focus on strengthening PHC, CHC, ASHA.
• NUHM: Urban poor → focus on UPHCs, UCHCs.
• Key pillars: RMNCH+A, NCDs, communicable diseases, infrastructure, human resources, and PPPs.

💡 Tip:
Say — “NHM = umbrella under which all vertical programs integrate for convergence.”

Under the UN SDGs (2015–2030), Goal 3 is directly health-related:
“Ensure healthy lives and promote well-being for all at all ages.”

Key health targets:

• Reduce MMR < 70/100,000 live births.
• Reduce U5MR < 25/1,000 live births.
• End epidemics of AIDS, TB, malaria by 2030.
• Achieve Universal Health Coverage (UHC).
• Reduce NCD mortality by one-third.

💡 Tip:
India’s National Health Policy 2017 aligns directly with SDG-3.

• Goal: Achieve Universal Health Coverage (UHC).
• Targets:
   • Increase public health expenditure to 2.5% of GDP by 2025.
   • Reduce IMR to <25, MMR to <100, TFR to 2.1.
   • Free drugs, diagnostics, and emergency services in all public facilities.
• Focus: Preventive & promotive care, digital health, health card, and intersectoral coordination.

💡 Tip:
Say — “NHP 2017 = Right direction for SDG-3.”

State aim → key strategies → screening process → integration.

Model Answer:
Launched in 2010 under NHM, NPCDCS aims to reduce premature morbidity and mortality due to NCDs through prevention, early diagnosis, and management.

Key components:
1️⃣ Health promotion – awareness on diet, exercise, no tobacco/alcohol.
2️⃣ Screening – adults ≥30 years screened at HWCs for HTN, diabetes, and cancers (oral, breast, cervical).
3️⃣ Management – linkage of screened patients to higher centres (NCD clinics at CHC/DH).
4️⃣ Capacity building of healthcare workers.
5️⃣ Surveillance through National NCD Cell.

💡 Tip:
Remember the 3 cancers screened: Oral (visual exam), Breast (clinical breast exam), Cervical (VIA).

Mission Indradhanush (MI) was launched in 2014 to achieve full immunization coverage of all children and pregnant women.

Goal:
Reach 90% full immunization coverage.

Intensified Mission Indradhanush (IMI):
Started in 2017, focused on high-priority districts and urban slums with left-out children.

Vaccines under MI:
BCG, OPV, Pentavalent, Hep-B, Rotavirus, PCV, IPV, MR, and JE (region-specific).

💡 Tip:
“Indradhanush” = Seven colours → symbolizing 7 vaccines initially; now expanded to cover 12 vaccine-preventable diseases.

Launched in 2007–08, NTCP aims to reduce tobacco consumption and exposure to secondhand smoke through:
1️⃣ Public awareness campaigns.
2️⃣ Enforcement of COTPA 2003 (ban on advertising, smoking in public places).
3️⃣ Establishing Tobacco Cessation Centres (TCCs).
4️⃣ School-based awareness programs.
5️⃣ Coordination with law enforcement and NGOs.

💡 Tip:
Mention “India ratified WHO FCTC in 2004 – legal backbone for NTCP.”

Why examiner asks:
Common CMS viva question; integrates malaria, dengue, chikungunya, filariasis, JE, kala-azar under one umbrella.

Model Answer:
NVBDCP integrates control of six major vector-borne diseases:

• Malaria
• Dengue
• Chikungunya
• Lymphatic filariasis
• Japanese Encephalitis
• Kala-azar (Visceral leishmaniasis)

Strategies:
1️⃣ Integrated vector management.
2️⃣ Early diagnosis and complete treatment.
3️⃣ Surveillance through IDSP.
4️⃣ Community participation and IEC.

Elimination Targets:

• Kala-azar → by 2025
• Lymphatic filariasis → by 2030
• Malaria → by 2030

💡 Tip:
If asked elimination status → India achieved <1 case/10,000 for Kala-azar in 90% blocks (2024 data).

Launched in 1976, this is one of India’s oldest national health programs.

Objectives:

• Reduce prevalence of blindness to <0.3% by 2025.
• Provide free cataract surgery, refractive services, and eye screening.
• Distribute free spectacles for school children with refractive errors.
• Eye donation & corneal transplantation promotion.

💡 Tip:
Mention “Avoidable blindness” — cataract, refractive error, corneal opacity — 80% preventable causes.

The WIFS program was launched in 2012 under the National Health Mission to prevent and control iron-deficiency anemia among adolescents.

Target groups:

• School-going boys and girls (class 6–12) aged 10–19 years.
• Out-of-school adolescents (through Anganwadi centres).

Dosage:

• 100 mg elemental iron + 500 µg folic acid, once weekly throughout the year.
• Albendazole 400 mg every 6 months for deworming.

How to answer:
Briefly describe the goal, target population, and the 6×6×6 approach.

Model Answer:
Launched in 2018, the Anemia Mukt Bharat (AMB) strategy aims to reduce anemia prevalence by 3 percentage points per year among children, adolescents, women, and men.

🎯 Goal:

To make India “Anemia Free” by improving iron status across all life stages.

👥 Target Groups:

• Children (6–59 months)
• Adolescent girls & boys (10–19 years)
• Women of reproductive age (15–49 years)
• Pregnant & lactating women
• Men (15–59 years)

⚙️ The 6×6×6 Strategy:

• Vector-borne: Malaria, Dengue, Chikungunya, Filariasis, Japanese Encephalitis.
• Air-borne: Tuberculosis, COVID-19, Influenza.
• Water-/food-borne: Typhoid, Cholera, Hepatitis A/E.
• Zoonotic: Rabies, Leptospirosis, Brucellosis.

💡 Tip:
Always link with corresponding programs — NVBDCP, NTEP, IDSP, and NCDC.

1️⃣ Confirm suspicion: Fever + headache + retro-orbital pain ± rash ± thrombocytopenia.
2️⃣ Assess severity: Warning signs – abdominal pain, bleeding, lethargy, rising Hct ≥ 20 %.
3️⃣ Investigate: CBC, Hct, Platelet count, NS1/IgM ELISA.
4️⃣ Treatment:
 • Maintain hydration (oral / IV crystalloids).
 • Avoid NSAIDs.
 • Monitor urine output & vitals.
5️⃣ Refer if: Shock, bleeding, platelet < 10 000, or persistent vomiting.

💡 Tip:
“Fluids save lives in dengue – not platelets.” (Ref NVBDCP 2024).

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Model Answer:

• Vision: Eliminate TB by 2025 (5 years ahead of SDG).
• Key components:
   1. Early detection via molecular tests (CBNAAT/Truenat).
   2. Universal drug-susceptibility testing.
   3. Free treatment including MDR/XDR regimens.
   4. Nutritional support (Nikshay Poshan Yojana – ₹1000/month).
   5. Private-sector notification via Nikshay portal.
   6. Active case-finding & contact tracing.

💡 Tip:
State government + private partnership = backbone of NTEP implementation.

Diagnosis:

• Rapid Diagnostic Test (RDT) or Peripheral smear for all fevers.

Treatment (as per species):

💡 Tip:
Always mention “Do G6PD test before starting Primaquine.”

UNAIDS targets:
1️⃣ 95 % of people with HIV know their status.
2️⃣ 95 % of those diagnosed receive ART.
3️⃣ 95 % of those on ART achieve viral suppression.

India’s progress (2024): 78-90-86 (approx).

💡 Tip:
India aims for 95-95-95 by 2025 under NACP-V.

• Vision: End AIDS as public health threat by 2030.
• Pillars:
   • Prevention through IEC & condoms.
   • Testing & counseling (ICTCs).
   • Free ART at ART centres.
   • Targeted interventions (TI) for HRG groups.
   • Viral-load monitoring for suppression.

💡 Tip:
“Treatment as Prevention” and “U=U (Undetectable = Untransmittable)” are key new concepts.

Model Answer:
1️⃣ Wash site immediately with soap & water (no spirit / bleach).
2️⃣ Report to infection-control officer.
3️⃣ Assess exposure → HIV/HBV/HCV status of source.
4️⃣ If HIV-positive source: start PEP within 2 hours → Tenofovir + Lamivudine + Dolutegravir for 28 days.
5️⃣ Baseline & follow-up testing at 6 weeks, 3 & 6 months.
6️⃣ HBV PEP: give HBV vaccine ± HBIG as per status.

💡 Tip:
“PEP within Golden 2 Hours – the sooner the better.” (NACO 2025).

Prevention ;- single scoop technique.

• Vaccine carrier = Insulated box used for transport of small quantities of vaccines from PHC to session site.
• Contains 4 ice packs, keeps temperature between +2 °C to +8 °C for up to 24 hours.
• Used by ANMs and ASHAs during outreach sessions under UIP.

💡 Tip:
If asked further, mention ‘Condition vaccine carrier before use by placing ice packs for 1 hour to stabilize temperature’.
(Ref: UIP Operational Guidelines 2024)

• Temperature: +2 °C to +8 °C.
• ILR used for storage of vaccines at PHC/CHC level.
• Freeze-sensitive vaccines ( e.g. Hep-B, Pentavalent ) kept in the middle basket – not on floor of ILR.

💡 Tip:
State simple mnemonic ‘2 to 8 to be safe for all vaccines’.

• Policy allowing reuse of partially used multi-dose vials for up to 28 days if:
   ✔ Vaccine not expired.
   ✔ Stored at +2 °C to +8 °C.
   ✔ No contamination or freeze.
   ✔ VVM (Vaccine Vial Monitor) not beyond discard point.
• Applies to: OPV, DPT, TT, Hep-B, Pentavalent.
• Excludes: BCG, Measles-Rubella, JE (vials without preservative).

💡 Tip:
Always record date and time of opening on label.

• Tetanus / Td: Two doses at least 4 weeks apart ( 2nd dose ≥ 2 weeks before delivery ).
• Influenza (inactivated) – safe in 2nd and 3rd trimester.
• COVID-19 (whole virus / inactivated type) – permitted under MoHFW guidelines.
• Contraindicated: Live vaccines (e.g. MMR, Varicella, OPV, JE live).

💡 Tip:
Remember: ‘Killed okay, live no way’ for pregnancy.

• mRNA vaccines contain messenger RNA coding for viral antigen (e.g. spike protein of SARS-CoV-2).
• Injected mRNA enters cytoplasm → translated to protein → immune system recognizes it → antibody and T-cell response.
• No integration into host DNA.

💡 Tip:
If asked, name examples – Pfizer-BioNTech and Moderna COVID-19 vaccines.

• Incidence = Number of new cases occurring in a defined population during a specified period.
   → Measures risk of developing disease.
   → Example: New HIV cases detected in Delhi in 2024.
• Prevalence = All existing cases (new + old) at a given time ÷ population at that time.
   → Measures disease burden or workload.
   → Example: Total known diabetic patients in a district register.

💡 Tip:
High prevalence with low incidence = chronic disease (e.g., diabetes); low prevalence with high incidence = acute fatal disease (e.g., cholera).
(Ref: Park 26/e, Ch. 2)

• Launched: 2018 under NHM.
• Two components:
   1️⃣ Health & Wellness Centres (HWCs) → Comprehensive Primary Health Care (CPHC) including NCD, mental health, palliative care.
   2️⃣ PM-JAY → ₹5 lakh cashless cover per family per year for secondary and tertiary care (10.74 crore families).
• Linked with ABHA ID and Digital Health Mission.

💡 Tip: Phrase like a CHS officer — “This scheme bridges primary-to-tertiary care continuum.”
(Ref: MoHFW Ayushman Bharat Dashboard 2025)

Employees’ State Insurance Act, 1948 – Benefits